Search Results for 'what muscles to inject'

[Heather34]

Hi all. For those who may be considering having the Botox treatment program for vaginismus in the coming year, there is an excellent description of what the procedure is like on Maze Women’s Sexual Health website.

Excerpts include:

“The procedure is done at the Westchester Ambulatory Surgical Center in Purchase, NY, only 10 minutes from our Purchase office.

On procedure day, the patient is prepped for surgery and given an IV and placed in a hospital gown.

Once in the surgical suite, the patient is put under conscious sedation for the procedure which takes approximately 20 minutes. Once the patient is under anesthesia, a full pelvic exam is performed and a pap test is obtained if indicated. Next, dilators are inserted into the vagina; this dilation starts the process of lengthening and relaxing the pelvic floor muscles. After the progressive vaginal dilation, a speculum is inserted and the injections begin. The botulinum toxin is first injected, a total of 100 units, into the tense muscles. The doctor then injects a local anesthetic in the vaginal walls and vaginal entrance. Once the injections are completed, the largest vaginal dilator is inserted. The patient awakens with the dilator in place. There is a recovery and rest period after the procedure. During that time the patient is taught to remove and re-insert the dilators, and she is sent home with the dilators and instructions. It takes 2-5 days for the botulinum toxin to take full effect so the patient is encouraged to continue to use the dilators as much as possible for the first few days. There is a follow-up visit the next day and an individualized follow up treatment plan is developed.”

[Heather34]

Dr. Pacik has written so many wonderful posts concerning conquering fear. One particular post that is a favorite includes the following:

“The fear of using dilators is perhaps one of the most common reasons women don’t think they can go through with the program. They need considerable reassurance and this is one of the major benefits of this Forum-to remove the unknown causing fear and replace this with reliable educational information. The fear of failing with dilators lingers after the treatment. Early on, it is all so strange but possible. Patience is important because with time it gets easier as the muscles are stretching and the Botox makes it impossible to go back into spasm. Even a few days of not dilating during menses is not a problem, one simply starts with a smaller dilator to get used to the dilation program once again. Now that the extreme fear and anxiety are abating, everything becomes easier”

Prior to my procedure, I was consumed with so many fears, including the fear of failing treatment because I was terrified of dilating post-procedure. In the past, I had ordered hard, plastic white dilators and tried so many times to insert them on my own with no success. Every single time, it felt like I was hitting a wall and caused excruciating pain and burning. How would I ever be able to use the dilators in this program if I wasn’t able to even insert the smallest one on my own after trying for years and years??? I seriously couldn’t have been more wrong and it took actually waking up from the procedure with a dilator inside of me to realize this. When I woke up with the largest blue dilator inside of me, this was the first time anything had successfully been inside of me period and I was in shock that it had worked, I wasn’t broken, and it didn’t hurt at all. Thereafter, with this knowledge and quite a bit of lidocaine/surgilube coating the dilators, I was able to insert the purple, pink, and largest blue right in and without the resistance and blocked wall feeling that I had always had. Now, the burning/pain/fear/wall was gone and this allowed both my husband and I to practice inserting, removing, and re-inserting all of the dilators pain-free. I delayed having the procedure b/c I was so afraid of this and then realized, after the fact, that it was entirely possible.

In an excellent recent success story that I read, it also discusses that overcoming fear is entirely possible with the right help and the right attitude.

Specifically, L, Age 29, wrote:

“I am a 28 year old who never had intercourse in her life. I’ve been this way always. I was afraid of the pain, and getting pregnant. I had been afraid that there was nothing anyone could do. At the last visit I made to my Gynecologist, he told me that it was all in my head…that I just needed to relax and it would happen. That made me feel worse because I knew it was not that easy for me to just let it happen. My boyfriend of 11 years, yes 11 years, was watching a show one day where they talked about many things including couples that were dating or were married for years and could never have sex. He told me about it and I started to cry. I thought I was the only one going through this, how selfish was I? After he went to bed I decided to Google more info about this other couples. After searching, I bumped into an article that talked about Vaginismus, a condition that does not allow you to have sexual intercourse. I was amazed about the number of women that were going through this. I was researching online for a place where I can find someone to talk to; a professional that could help me and my boyfriend get through this once and for all, and I found Maze Women’s Sexual Health. I felt weird right before I made the phone call, but at the same time I was extremely excited and hopeful to find a solution to this problem I was having. I was also a bit nervous on my first appointment, but everyone was so nice and friendly that I felt at ease right of way. Since the dilators didn’t work out very well for me. I decided to go for a more unconventional treatment. The botulinum toxin treatment was the best approach for me because it helped me overcome the fear of having something in my vagina.

The treatment went as follows:
They put me to under conscious anesthesia for a procedure that took about 15 to 20 min.

After putting a topical anesthetic in my vaginal walls the doctor injected the area with botulinum toxin. After the muscles relaxed a large dilator was inserted and I woke up with it already inside. It was such an overwhelming experience waking up with the dilator inside of me. I felt accomplished.

Within a week and a half my boyfriend and I were able to have sex. It takes some getting used to. This is a new experience for me; for us. But we are working on it. I still follow up with the Nurse Practitioner, to see my progress. As for me, I feel amazing. I’m Happy. I feel like a woman.

Fear is a part of life. Lesson learned, you can get over it, with the right help and the right attitude, fear can be overcome. I would want other women to know that they should not let fear of the unknown control you. It’s never too late to search for help. I just wished I would’ve found out about my condition sooner.

Vaginismus is not something that people talk about. And if it wasn’t because of that show my boyfriend saw, I would’ve never done the research and I would’ve never looked for help.

It took me too long to figure out what I had was not all in my head. Don’t be afraid to get help. You are not alone.”

To the veterans reading this, how did you overcome your own fears pre-procedure? Any advice would be so helpful.

[Heather34]

Hi Melissa. Welcome to the Forum. This is an absolutely wonderful post and I am so, so, so happy that there is a group out there that will continue to offer the Botox treatment program for vaginismus. It is so exciting that 5 patients were treated over the last 2 months and 6 more will be treated this coming month of November. Ladies and husbands/partners please, please join the Forum and post, post, post and ask any questions at all and know you have all of our support.

As the year of 2015 comes to an end and a new year is about to begin, this post makes me smile so huge and so sincerely happy. For several years of my life (all of my 20s and early 30s), I did not know how to overcome vaginismus and felt hopeless that I ever would. I was excellent at distracting myself with various other life activities/etc. but every year, I made a list of my top goals and every year until 2012, “Cure V” was at the very top. I wanted to overcome so we could finally make love and start our family. I tried using dilators alone but was completely unsuccessful and later tried pelvic floor PT but, again, was not successful because I could not insert a thing without the pain/resistance response. Then, thank GOD, I found Dr. Pacik’s Botox procedure for vaginismus and had the procedure in 2011 and was cured and finally able to make love to my husband and we now have a beautiful baby boy (both are dreams come true).

I have read so many member’s stories and have my own story (see above) of seeking and receiving several failed treatments for vaginismus. How many of you have heard a doctor or clinician suggest to “just relax”, “don’t think about it”, or “just do it”? The pain associated with vaginismus is not “in the women’s head” and does not readily respond to these suggestions. Vaginismus is a ‘real’ physical pain and the Botox treatment for vaginismus works to address both this physical pain and to also diffuse the fear of penetration. First, the Botox injections work to weaken the tight vaginal muscles that often make penetration impossible. Second, waking up with the dilator already in place works very well to diffuse the fear associated with penetration. For some patients, such as myself, this was the first time that something was inside of me “pain-free” and, in realizing this, it entirely eliminated any anxiety associated with penetration. The uniqueness of this combined approach to vaginismus makes it work so, so well.

Several others have also posted on trying so many treatments prior to receiving the Botox treatment program and their experiences:

Reese writes:
“Prior to the treatment with Dr. Pacik, I had tried what felt like everything under the sun. I had done physical therapy, biofeedback, etc. I had suffered from vaginismus for 7 years prior to the treatment. However, doing the treatment was the best thing that ever happened to me. My treatment cost (not including flight and hotel, of course) was $5250, and insurance reimbursed me $3756. This was a HUGE help for me. The only reason I saw a reimbursement was because Diane Tremblay fought hard for many hours with my insurance company until they paid the proper portion of the claim. She is worth every penny, as is the treatment!!!!! Note: Even if you do not get the procedure covered under insurance, I can assure you it will be the best money you have ever spent. It will relieve so much pain and bring so much happiness into your life. I would have paid three times the amount if I had to.”

lotus1000 writes:
“I had done various OBGYN exams, including one angry OBGYN who yelled at me in his Russian accent “totally unacceptable!” when I scooted away during a speculum exam. I went to vaginismus.com and ordered those dilators. I tried getting my husband to use his fingers. I used tampons. I went to counseling (even with a sex therapist). I then considered going to IVF so I could bypass intercourse as a way of getting pregnant. After 6 years of all of this, where I essentially chased my tail again and again, I found Dr. Pacik’s site and just had my treatment this past week!”

Nakitalab writes:
“At the age of 52 I felt like I had tried every treatment under the sun. From surgery to include hymen outer ring removed, episotomy, and scar tissue removal, anti-depressants, alcohol, counseling, sex therapy, dilators, etc. I had my procedure in October and just 14 days after the procedure was able to have intercourse with zero pain. It is now day 119 and I still have no pain…”

Thank you so much Melissa and to your group, Maze Women’s Sexual Health, for continuing on Dr. Pacik’s amazing work and offering the Botox treatment program for vaginismus. I look so forward to reading your future posts.

[Heather34]

Hi Leonielee. Huge Congrats on having your recent procedure. I wanted to share with you some thoughts which includes a prior post of another Forum member who also had a partial hymenectomy in addition to the Botox injections. Please, please know I am here for you always!!!

Bethany writes:

“Hello!

I had my Botox treatment yesterday (Monday, the 13th). The whole day was pretty much a blur! I was so nervous and unsure…didn’t know what to expect.

My husband was in the procedure room with me and saw everything that Dr. Pacik was doing.

Dr. Pacik did have to remove some small amount of tissue from around my hymen. Because of this, I did have some pretty extensive (in my opinion) bleeding afterwards. I was only prepared for a small amount of spotting. So, the lots and lots of blood was somewhat scary for me.

I did wake up with the Blue #6 dilator in place. I was completely numb still, so it felt completely painless. I was also then able to take out Blue and insert Pink. By then the numbness was wearing off a bit. Pink was not too bad to get in and out. Then, it was time to head home with Purple in. By this time I was fully out of the numbness. I felt every inch of #4. The ride back to the hotel was pretty awful. I cried most of the ride. My emotions were all over the place. I then proceeded to make a very teary call to my mom, blabbering about bleeding and pain and uncomfortableness, etc.

I kept #4 in for several hours after we got back to the hotel. I even fell asleep for a while with it in.
I then took it out for an hour or so, for a little break.
I inserted #3 blue for a while, which was obviously more comfortable.
Then, I switched back to the purple #4 to sleep last night.
I did take some Advil PM and that seemed to help. I do agree with many of the other posters who talked about sleeping on your side with a pillow between your knees. That definitely helped.

On Day 2, returning to the office for counseling- I started the morning off by taking out Purple #4 to shower. Then, I started back at #3 blue for about 15 minutes. Went back up to purple and we drove to the office. Still pretty uncomfortably. I was clenching my teeth and muscles the whole time there.
Once we arrived we worked on some dilating with Dr. Pacik. It was not impossible to get pink it- but, it was not fun either. I did attempt Big Blue without success. This was okay, but still a little disappointing.

After we finished at Dr. Pacik’s I left without any dilator in place and we took the afternoon off to see some of the NH countryside. It was a really good time of bonding and sharing time with my husband. We did talk some about the procedure and my vaginismus (more than we really have in the past!). Then we came back to the hotel and I attempted to dilate with the #4 (purple) glass dilator. It was easy to insert, more painful to leave in and it kept slipping out(even with tight panties, two pairs, a pad and leggings) I was able to leave it in for a little while and then switched to the silicone #4 purple.
Sitting in the dilators seems IMPOSSIBLE! Will this get better when the Botox kicks in???!!! I could dilate ALL Day if I could sit and get work done at my computer without being in excruciating pain. I kept trying to contort myself into crazy positions to see if I could tolerate the dilator sitting down somehow. Any Advice on this would be GREATLY appreciated! At this point, standing it the most comfortable position for me. Standing and not moving! Ha! Okay…I will just stand still for two hours everyday… Laying down on my back is also okay…but not as comfortable as standing.

After leaving the #4 purple in for nearly an hour, I attempted to go back up to #5 pink. I was able to get it most of the way in, but the searing/burning was still present. It actually felt better when I moved the dilator in and out-as strange as that seems. I was only able to tolerate it for a short time, standing up and holding it in place.

Now, I am SOO sore. Oh my goodness. I feel like my downstairs has been put through a clothes wringer. I have been taking my regime of Advil today and will take some Advil PM here in a moment.

I think I was under somewhat of a false idea (of my own making), that I would just magically emerge from the procedure and be pretty much cured. Not that I wouldn’t need to dilate, but that I would not feel the considerable pain I am currently feeling while dilating. My case of vaginismus is considered somewhat less severe, so I am not sure if this is why I created these false hopes.

I know I am only one day after the procedure, but I guess I am still feeling somewhat discouraged at the amount of pain. This is the kind of pain I have been avoiding for the last 5/6 years and it just brings up lots of bad memories.

Is there any reassurance that dilating will get less painful when the Botox kicks in?
Also- when do you stop feeling SO sore?

Thank you everyone!! I appreciate it.
I have already been encouraged by many posts on here.
xoxo
b. “

My reply:

“Hi Bethany. Huge, huge CONGRATS on having your procedure! I am so very happy for you!!! Please know that all of what you are feeling right now post-procedure (so happy to write post-procedure) is very common. Remembering back to after my own procedure in 2011, I had to dilate with the pure romance dilators while lying down on our couch for a while. I, too, always felt like they were the most comfortable to have in while standing or lying on my side on the couch. Every single person is different but I never remember sitting upright with the dilators in until I got the glass ones many months post-procedure. At that point, I was adequately stretched from both dilating in the past with pure romance and intercourse and I think this is why it didn’t hurt while sitting straight up. I still, however, sometimes sat on the side of my butt which I’m sure looked quite interesting to my co-workers as to why I looked so relaxed brief writing. I promise you so much that the sitting thing does get much better in time. I also wanted to share a great link that Vashalla posted in the past about a special chair she ordered from Amazon that helped her while dilating:

Sitting Success

http://www.vaginismusmd.com/vaginismus-md-forum/?mingleforumaction=viewtopic&t=513

You also asked:
Is there any reassurance that dilating will get less painful when the Botox kicks in?

Post-procedure, I noticed that dilating got a lot more comfortable as the Botox kicked in and the more days that I did it. I found it to be a roller-coaster at times in my first week post-procedure – a couple of days very good dilating with little pain and then a day that was very uncomfortable and then back to less pain the next day. Dr. P has written about this roller-coaster that occurs and I wanted to share a couple of helpful posts with you.
Mabel 1226: I think the best way to think about this is this: the muscles in our vaginal walls have never really been stretched before. I keep telling myself I wouldn’t expect my body to be able to run a marathon if it had been in a wheelchair for 20 years. I, too, felt “guilty” for starting back at the purple before going up again. I am now 54 days post-procedure and still can’t get the blue glass in unless the pink glass has been in for 2 hours. One step at a time. You’ll get there in your own time and in your own way. Don’t get discouraged!
Dr. Pacik: Post procedure dilation is a “roller coaster” ride during the first 1-2 weeks after treatment. The muscles are still tight and “talking back” as they are being stretched. Since most women feel they will be the one person for whom Botox does not work, any difficulty with dilation immediately verifies these feelings. Then the muscles loosen up as the Botox is taking effect and the week or two of dilation is starting to be noticeable with less pain and therefore less anxiety. Now it is just a question of continuing with the program of dilation, and most of my patients at this stage begin thinking of transitioning to intercourse.
SP: Dr. Pacik is correct that dilating early on is a roller coaster ride. You are making progress and definitely celebrate every success! Even once you start trying intercourse you will have days where it goes smoothly and days where you wonder if the procedure worked. Stay positive and keep trying. I remember thinking will intercourse ever not have to be a “robotic” process. A little over 3 years now from my procedure I can tell you I rarely have to worry or get prepared to have intercourse. You are doing great and soon you will not even think about all the dilating and struggle. 🙂

You further asked:
When do you stop feeling SO sore?

I definitely felt soreness for a couple of weeks post-procedure as there was just so much activity in the area where before there was none. Most recently, a November treated patient wrote a great post with a suggestion for Hydrocortisone cream and this was followed up by Dr. P:

“Dr. Pacik’s suggestion to use Hydrocortisone Cream has been a HUGE help for me. My lady bits are just so dang sensitive!!! I bought Hydrocortizone10 in the Cooling Gel formula for during the day and I’ve felt SO much better – then I’ve been using the Hydrocoritzone10 in the ointment for adding to my lube mix with dilating at night. I honestly can’t believe how much that’s helped me feel better the last couple days.” –

“It is common for women to have some skin irritation as a result of post procedure dilation. There is suddenly a great deal of penetrative activity that did not exist in previous years. 1% hydrocortisone is an over the counter topical that is anti-inflammatory and can be purchased either as a cream (faster acting) or as an ointment (longer lasting). It is generally used as a pea sized amount rubbed into the irritated area twice a day and can be used for 1-2 weeks.”

Finally, Bethany, I wanted to leave you with one of my favorite posts post-procedure that examines the roller-coaster that is dilating in the immediate days right after the procedure but that it does get much, much better (see below)!!! I am, again, so very happy for you and your husband and am right here for you always!!!!!!! You are doing excellent!!!!!

Firenze:
So I officially had (am still having) my first meltdown post-procedure. In my last post, I wrote about how I was having trouble with the blue dilator (#6) and now I’m having more and more problems with pink, #5. Up until a few days ago, I had no problems at all with it. Last night, after dilating with purple, I put pink in, but it was the most uncomfortable it had been until this point. I was only able to keep it in for about 30 min. I slept with purple overnight with no pain or problems and dilated with it for about an hour this evening (again no pain) before trying pink. It took 30 minutes for me even to get pink in! The longest until today, has been about 5 minutes to insert. Once I got it all the way in, it was so uncomfortable, I had to take it out after a few minutes. The weird part is that it didn’t really hurt at all (just resistance) until I got it in that last bit. I know there will be bad days, but I really thought it would be getting easier and easier to use pink, not more difficult by the day. I’ve been upset ever since I took it out. Will backing down for more than a day help? I’m not sure what to do. If anyone else has experienced this, please let me know what worked for you.

Firenze:
Hi everyone, I came down with the flu and was unable to share the exciting news that me and my boyfriend were able to have intercourse after 5 years of being together!!! It doesn’t even feel real typing that 🙂 It happened this past Saturday, on Day 11, right after I was having a couple of really frustrating days in a row. It goes to show how much of a rollercoaster this is!
Late last week, I had been having a lot of trouble with pink (long insertion time and soreness). I took it easy that Friday, dilating with only purple and sleeping with it overnight. When I woke up Saturday morning, I decided to try pink again and it went in much easier and I had a lot less soreness. It seems like the morning is a much better time for me to dilate, so I wish this was more of a possibility for me during the week. Anyway, my boyfriend and I decided to try intercourse after I had pink in for a bit, completely low pressure! We just wanted to see what happened, but I kept saying if it didn’t happen, not a big deal, which helped a lot with my anxiety. We tried missionary and it worked!!! I didn’t have any pain which completely surprised me after I had been having so many issues with soreness. We didn’t try any thrusting and I didn’t want it to end haha. We haven’t been able to try since then because I’ve been sick, and I’m scared and excited to try again! If we did it once, we can do it again, right? 🙂 Dr. Pacik’s program and the botox helped me achieve in 11 days what I had been working to do in physical therapy for over 2 years! Thanks to everyone here for their support!”

[Heather34]

Hi all!!! I know that several of you have your procedures coming up soon. 4 of you have posted about having procedures in May as well as July! I want you all to KNOW that you will have tremendous success and you are so strong and courageous for taking this step and the stand to defeat vaginismus once and for all.

In writing this, I keep thinking of Dr. Pacik’s blog: David and Goliath. http://www.vaginismusmd.com/david-and-goliath/

In it, he writes: “Speak to the patient. I value each and every conversation I have with my patients before treatment. It helps them understand, helps them overcome some of their anxiety and sets the stage for good communication after treatment. It always gives me some additional insights into what is going on for the patient, and once again I learn something about the struggles of vaginismus or a concept that is re-enforced. Slowly, even at this stage we are beginning to “know the enemy”. Knowledge is power. The first strike comes in the operating room. Under anesthesia, Goliath has been rendered helpless as the anesthesia takes effect and reduces the muscular spasm to nothing more than an easily stretchable muscle. The power of spasm becomes jelly. The tightly closed fist of the entry muscle disappears. Botox is injected while the enemy is unconscious. Before Goliath regains consciousness, the muscle is dilated to one of the larger dilators and a long acting local anesthetic is injected to keep the powerful enemy weak after he wakes up. This results in a crippling blow . . . BUT The enemy wakes up, and though weakened, Goliath can still rear its ugly head. The fight is now a balance between the dueling dilators of David and the powerful muscles of Goliath that have been weakened but not yet controlled. David fights on knowing that once the arrows delivering the Botox become effective he will be able to continue to weaken his opponent. The long acting anesthesia allows the patient to continue dilating for several hours after treatment, without fear. During this time David is further coached on how to overcome the enemy. Hours are spent learning how to prepare daily logs for continued follow up, how to transition from dilators to intercourse, how to become erotic once again, positions of pelvic floor relaxation to make intercourse more comfortable and how to prepare for GYN exams. Much more is taught, but these are the basics leading to victory. More knowledge, more power. Goliath is held at bay, and weakened he begins to fall. Knowing that Goliath has been weakened gives David the final determination to throw more dilators at the monstrous muscles. Continued daily logs are showing greater comfort using the dilators as anxiety diminishes. The battle at times feels long, but the powerful Goliath is weakening. It is hard to believe, but the end is in sight. David conquers and the story ends as it should. The underdog wins. Intercourse is suddenly possible without pain. It takes David a little longer to overcome the stress of the battle. “I need to catch up emotionally to where I am physically” simply indicates that any of us need to get beyond stressful times, and this may take awhile. David believed in God, and God helped him win over the giant.”

I’m here for you all and, again, KNOW that you will have tremendous success and you are so strong and courageous for taking this step and the stand to defeat vaginismus once and for all. Sending many prayers your way as well as huge hugs!!!! Can’t wait to read your future posts!!!!

[Heather34]

Hi Flufy2015. I can totally relate to what you have written. I always no matter what felt pain and tensed up whenever I would try for an exam and the doctor would even go near the area and also when my husband would even try to insert a finger. It was so frustrating. Right after my procedure, I had to warm up to the idea that my hubby would be there with me as I practiced dilating. I was uncomfortable with this mainly because we had reached the point in our marriage of just not talking about our problem with vaginismus and now, we were right there facing it head on. Thank God, the awesome staff and Dr. Pacik talked me through this and I realized how important it was to involve my husband. Then, while I practiced inserting, removing, and reinserting the dilators, he was right there with me and I even placed his hand on my hand during this. For me, it helped to open up our communication so much more and helped me to trust this was ok and something good that we were experiencing together. For him, he was so happy to be witnessing something such as the dilating that wasn’t hurting me and could fit and go in pain-free. It was truly a bonding experience as a couple. Dr. Pacik is so great and so knowledgeable about both the physical as well as emotional issues that we have with vaginismus. He can pinpoint the exact muscles and inject the Botox and this makes the wall of resistance dissipate which allows for pain-free insertion of the dilators. Also, during this physical treatment, he and the staff help you with the emotional challenges of vaginismus (i.e. fear, anxiety, relationship, transitioning to intercourse, etc.). It is a wonderful combination of elements that makes the overall program work so well. Please know I am here for you always! Sending you hugs!

[sopranochica]

Hi all,

My name is Serina, and I am currently (as of 12/10/14) 2 days post-procedure. My husband and I have been together for 5 years, married for almost 3. To make a very long story short, we tried everything. Topical lidocaine injections/creams, other dilators, the whole 9 yards. Nothing really worked, much to our frustration. My husband did some research and found Dr. Pacik, and I made the call in early October. I’m very glad I did, because I now have hope where there was none. I feel that all my concerns were addressed (both physical and psychological), and that I will finally be able to have pain-free intercourse. I’m still in the dilating phase, and might be for a couple of weeks. My poor spasming muscles need time to rest! 🙂 But I will definitely update when we have been successful.

[Dr. Pacik]

The Botox multimodal program of Botox injections and progressive dilation-all under anesthesia, combined with post procedure counseling and support with follow up makes the treatment process easier and faster. For those who dilate on their own, one has to be perseverent with the dilators, progressing slowly from the small to the larger dilators. The muscles need to stretch, and this cannot be rushed.
Please refer to http://www.plasticsurgerypa.com/dilators-for-vaginismus-correct-use-2/ to get a better idea of how to progress with dilators. You can also read the book written by Heather Jeffcoat, DPT “Sex Without Pain.

[Heather34]

Hi ladies. There are so many different elements that made Dr. Pacik’s treatment program work for us when countless other avenues that we tried failed. In examining this, some crucial parts were having the procedure under anesthesia and waking up with the dilator in place and also having Dr. Pacik believe me when I said any form of penetration is impossible. An excellent blog actually describes all of these elements that worked for us:

http://www.vaginismusmd.com/why-is-dilation-under-anesthesia-so-important-in-the-botox-treatment-of-vaginismus/

Excerpt:
The Tightly Closed Fist and the Vaginismus Woman
“If one can just imagine a tightly closed fist and then trying to insert a finger from your other hand into that closed fist – the finger cannot enter – it is just impossible – it seems like you are “hitting a wall”. This is exactly what it is like for women suffering from severe vaginismus when they are trying to dilate or having any type of penetration or intercourse.”

My comments:
Instead of saying as other doctors had said in the past “just relax and try to use dilators or consume copious amounts of alcohol”, Dr. Pacik recognized the very real physical block (i.e. spastic muscles) that prevented any insertion despite how hard I willed this to happen and wanted it to work. This was so important for both my husband and I.

Excerpt:
Dilation Under Anesthesia with the Botox Treatment
“Our Botox Treatment Program for vaginismus is so unique because our patients are put under anesthesia for their Botox injections and for their post-injection dilation. By using vaginal Botox injections and inserting a dilator under anesthesia, patients obtain fast and dramatic improvement. Vaginismus sufferers who previously could not tolerate being touched are able to self-dilate to the largest dilator within three hours after their procedure. They continue to self-dilate the next day even after the long-acting anesthetic has worn off, and before the Botox has taken effect. Some may even allow their partner to assist in dilating!”

My comments:
I tried so hard to have an exam and wanted to but just couldn’t do it. When the doctor even touched the outside area of my vagina, my butt lifted off the table and I felt like I was going to die because of such intense fear/pain response. By being placed under anesthesia, I could finally take the first steps in overcoming vaginismus. I went from never being able to insert even a q-tip to being able to successfully insert, remove, and reinsert the largest blue pure romance dilator within hours of the procedure. My husband also assisted and we both were in shock as it was actually happening and I did not have my normal response of “no, no, no” or pulling away and retreating.

Excerpt:
Seeing and Feeling the Dilator an Aha Moment
“Time and time again, we are able to witness many of our patients waking up from anesthesia and realizing that they have a dilator in place. They are all thrilled to realize that their anatomy is normal and that their body can accommodate a dilator! This is truly an aha moment — a defining moment where they gain real wisdom — wisdom that they can use to change their life! This gives me great joy.”

My comments:
This truly was an Aha moment for me and one I will never forget. I woke up with the dilator in place and immediately had to use the bathroom. I took it out, went to the bathroom, and then inserted right back inside in the standing position. I couldn’t believe it and was so, so, so happy. I am not sure if I ever would’ve been able to insert the dilators if I didn’t have this moment of waking up with the dilator already inside and knowing that I was not broken and something could be inside of me and also getting used to the feeling of it. I may have been able to but I believe it would’ve been more of a struggle and I needed this moment to progress forward.

Excerpt:
Success with Dilation Leads to Intercourse
“It is always uplifting to witness a woman with Lamont Level 4 or Pacik Level 5 vaginismus to wake up from the anesthesia to realize that she has a dilator in place. One of our early patients later told me that waking up in the recovery room with the dilator “flipped a switch” in her brain. Unable to tolerate any form of penetration due to intense fear, she progressed from treatment to intercourse in 12 days and sent me the following email: “Day 12: My husband & I tried to have intercourse for the first time. It actually happened!!!!!! LOL. I felt relief and so grateful that I wasn’t the one person the Botox did not work on. I feel like I have a real marriage now. I feel triumphant! Thank you God and thank you Dr. Pacik!””

My comments:
The same thing happened for us – thank God and thank Dr. Pacik. We practiced with the dilators while in NH and then went home and faithfully dilated daily and then transitioned and both were, again, in awe that it happened and did not hurt at all. Going from where I was (i.e. no, no, no) to that point was one of the best feelings of both of our lives and we continue to be so, so, so grateful to Dr. Pacik and all of the staff in New Hampshire.

What elements helped this program to work for you?

[Heather34]

Hi all. There is an excellent Press Release just published on Dr. Pacik:

http://www.digitaljournal.com/pr/2274498

Excerpts include:

“A recent study by Peter T. Pacik, MD, FACS, shows a 90+% success rate in treating vaginismus, a condition which many health care providers fail to recognize yet effects between 1 and 7 percent of all women worldwide. This multimodal approach for the treatment of vaginismus expands on a prior FDA approval for research in this field. Treatment utilizes a combination of BOTOX® injections and progressive dilation under anesthesia as well as post procedure supervised dilation, and sex counseling.”

“The BOTOX® vaginismus treatment program continues to have high levels of success helping to relax and stretch the vaginal muscles which interfere with the ability to consummate relationships” states Dr. Pacik about his treatment program. The program addresses both the physical spasm noted in women suffering from vaginismus as well as the psychologic aspects of fear and anxiety to penetration so prevalent in this population.”

“BOTOX® alone, without the full program including post-procedure counseling and follow-up is a setup for failure as has been seen in several patients,” explains Dr. Pacik about the treatment.”

This is a wonderful Press Release. Thank you Dr. Pacik for continuing to do so, so much for women with vaginismus and for breaking down the walls of silence and isolation that so often accompanies this condition!!!

[Heather34]

Hi npaul. Welcome to the Forum and thank you for your post. I am so, so excited for you to have your upcoming procedure in October. I struggled with vaginismus for several years and the majority of my relationship and marriage prior to finding Dr. Pacik’s treatment. I tried several other treatments prior, including using dilators on my own, PT, biofeedback, etc. and nothing worked. Thus, I was convinced that this, too, would not work. My husband, on the other hand, wanted to try it and we did … thank God. We had the procedure on June 27th and were able to have pain-free intercourse on July 4th and continue to enjoy such. There are so many different elements that I believe made this program work when all of the others didn’t and Dr. Pacik himself was definitely the biggest factor. In addition to being kind, caring, and compassionate, he is also incredibly knowledgeable about all aspects of vaginismus and the symptoms experienced, including heightened anxiety and the physical resistance feeling with any attempted insertion.

I want to share one of my favorite Blogs from Dr. Pacik with you: Vaginismus Treatment – The 1, 2, 3 Punch: http://www.vaginismusmd.com/vaginismus-treatment-the-123-punch/ Excerpts include:

“The first punch is the injection of Botox under anesthesia. This is the knockout punch for the spastic muscle at the entry of the vagina (the “closed fist”). It will be unable to recover for about four months. The second punch is the progressive dilation under anesthesia, stretching the tight muscle(s). Once these muscles are weakened and stretched under anesthesia, the continued post treatment dilation keeps these muscles stretched. The third punch is reduction of anxiety. It is well known that fear and anxiety play an important role in continued spasm of the entry muscle. The brain says “PAIN“, the vagina responds with a protective reflex “NO ENTRY“. Once fear and anxiety lessen and women are able to tolerate penetration as well as having comfortable pain free intercourse, this protective reflex appears to diminish, and the reflexive spasm of the vaginal muscles appears to disappear.” It goes on to describe the importance of post-procedure care: “The three punches described must be combined with careful post-procedure monitoring, which includes the review of daily logs to help patients with their post-procedure dilation program. The counseling done after treatment is of utmost importance to help women understand what needs to be done when they return home and the steps needed to succeed in having pain free intercourse.”

Please know we are all here for you. In addition, I wanted to direct you to another thread in which 3 October patients have also posted (two who will be treated on 10/1 and one will be treated on 10/13). http://www.vaginismusmd.com/vaginismus-md-forum/?mingleforumaction=viewtopic&t=933.0#postid-5061

Sending you huge hugs and support!!!

[Heather34]

Hi ladies. There is a recent July 2014 article concerning the use of Botox to treat vaginismus:

http://www.thehealthsite.com/sexual-health/how-botox-can-help-with-vaginismus-and-improve-a-womans-sex-life/

Excerpts from the article include:

“‘Botox has the property of relaxing neuromuscular junctions of muscles when injected by bringing about synaptic transmission interruption that keeps the vaginal muscles relaxed which couldn’t be achieved by other non-invasive means, thus allowing penetration and consummation,’ explains Dr. Pandey. The injection is given under deep anesthesia to relieve women from the vicious cycle of involuntary vaginal spasms.”

First, I will say that I am so, so happy to see Botox for Vaginismus mentioned as a treatment modality in the media and commend the author for writing about it.

I also wanted to briefly note that I believe Dr. Pacik’s entire treatment program, which includes Botox injections, but also includes waking up with the dilator in place, then learning how to dilate, then counseling, and finally, post-procedure follow-up and care, really made this work for us when so many other treatments failed. Also, and so importantly, is how much Dr. Pacik and the entire staff at his clinic truly care about you and support you every single step of the way. To know that he believes in you 100% is truly one of the best feelings in the world and instills confidence and helps you to believe in yourself and achieve tremendous success.

There have been many stories about failed Botox treatments for vaginismus at other clinics and locations. Julisa from the Caribbean, had two courses of Botox treatment in her home country and both failed. No post procedure support was given. After struggling with inability to have intercourse for seven years, she received Dr. Pacik’s Botox Treatment Program for Vaginismus and achieved pain-free intercourse at seven weeks. At 3 months she writes: “I’m having intercourse 3 times a week and it does not hurt at all. I’m just a little tense in my legs but that’s nothing. I’m glad it doesn’t hurt at all. And tell you the truth, I enjoyed it the last time we did it. It was different than the other times.” This is a wonderful testimonial.

Ladies, what do you think makes Dr. Pacik’s treatment program work when other treatments have failed? How important is the follow-up support and care? For a new woman considering this treatment, what advice do you have?

[Heather34]

Hi viv! Welcome to the Forum and thank you for your post. I am so, so sorry for your struggles with vaginismus and am beyond happy that you are in touch with Dr. Pacik and will receive treatment. Please know that I am here for you along your journey of overcoming every step of the way! I suffered with vaginismus all through college and, like you, tried with so many people and, despite every effort in the world, it wasn’t happening. I felt that although I mentally wanted it, with each attempt, my partner could not get past the “hitting a wall” feeling. This also made all gynecologist appointments impossible as well. What made Dr. Pacik’s treatment work so well for us is the “wall” that I described dissipated after I woke up from the procedure with the dilator in place and then practiced doing the progressive dilation. My muscles still had to stretch but the impossibility of something ever going in beyond the “great wall” was gone and the dilators and later my husband could slide in without resistance or pain. I know I have said this above but I am just so, so, so happy you have spoken to Dr. Pacik and will be treated coming up. He along with all of the office are beyond amazing and, so importantly, they care so much for you as the patient and understand so much about the condition of vaginismus.

As for speaking about this with your mom, I’d like to share some tips:

Personal Letter to the Family of Vaginismus Sufferers http://www.vaginismusmd.com/stories/letter-to-the-family-of-vaginismus-sufferers/#sthash.JwuvTvg1.dpuf

In addition, and I think of great importance, is testimonials from parents and family members of vaginismus patients.

The Mother of a Treated Patient writes:
kfmom: “Today marks one week since my 19 year old daughter’s procedure with Dr. Pacik and his wonderful team. It is difficult to put into words but what a life affirming experience it was and continues to be! I am writing this update in the same thread as “Reaching Out to Young Women” so you can get a sense of what it is like to be accompanied by a parent vs. a spouse or significant other. Others have written at length about the actual procedure itself. Suffice it to say that my daughter (K) was treated with compassion, respect and dignity. By her choice, I was by K’s side throughout the pre-surgery exam, surgery, recovery and counseling/follow-up. In retrospect she realizes that what her imagination conjured up in anticipation, as is often the case in life, was much worse than reality. Dr. Pacik talked her through each phase of the process, helped ease her fears and administered medication when warranted. Once under anesthesia K has no recollection at all of her experience. She, like the other 250+ of Dr. Pacik’s patients, woke up with a #6 blue dilator in place. This is when the real healing began. The curtains were drawn back and we were introduced to a young married couple who struggled with vaginismus since their wedding night almost two years ago. We also were joined by a recovered vaginismus sufferer who was observing that day and collaborating with Dr. Pacik. Be sure to check out her blog http://www.myvaginsmustory.com. After a brief awkward moment or two, over the course of the next day and a half stories, laughter, frustrations and fears were shared. It was very helpful to K to hear from others who have the same condition. Both K and the other young woman treated were able to proceed immediately to #5 and #6 dilators the next day with minimal discomfort. In fact, K had very little discomfort after the procedure at all – just taking some Advil on day 1. Yay! She continues to make good progress and we are very hopeful that she will join Dr. Pacik’s success stories. For young women reading, I want to assure you that Dr. Pacik and his team checked with K every step of the way about her desires and whether or not she wanted me present for each step. I, of course, also told K that I would leave with zero hard feelings whenever she asked. This was her treatment and her recovery. I am honored that she chose to include me and know that we will remember the experience always. Although recovery from vaginismus is a journey and K has not arrived at the end point yet, she already seems so much lighter … as if a huge burden is lifting. I want to thank every member of Dr. Pacik’s team for the wonderful care they provided. You have my commitment that I will continue to advocate for increased awareness and understanding of vaginismus. It is time for the shroud of silence to be lifted. K is hopefully one of the lucky ones who will find resolution early in her adulthood. So many others are not so fortunate. This is a real tragedy when effective treatment is available. Once again, we cannot thank you enough.” http://www.vaginismusmd.com/vaginismus-md-forum/?mingleforumaction=viewtopic&t=726

The Father of a Treated Patient writes:
PomPom: THE THINGS A FATHER WILL DO FOR THEIR CHILDREN My dear daughter had a problem , but it was a secret for years, she complained that she couldn’t use a Tampon, and everyone else could. What was wrong with me??? We took her to a world renowned Gyn, who performed a Hymenectomy and told her she was fine. She was told ” go get some help, see a Psychiatrist”!! We did and no results! She found a Psychologist who helped her somewhat , but not enough! My daughter decided to research her issues and found Vaginismus. She found her problem and opened up to me wife and I. We found Dr Peter Pacik and after multiple conversations and consults with my wife and I , and then with my daughter separately, off we were. I am in medicine as well, and in 30 years I have never met a man with the qualities Dr Pacik exhibited. He spoke to my daughter privately and in our presence , and I was asked to be present in the OR for support and to become educated on her problem. During the procedure , he explained every step to my daughter and educated me on what a burden she carried. Step by step my daughter was reassured “SHE WAS NORMAL”, normal anatomy, normal feelings and a very spastic vaginal muscle. He informed me of each injection of long acting lidocaine, the amount and location of Botox ( Dr. Pacik is the only physician with FDA approval for the use of Botox in treatment of Vaginismus). A dialator was placed from smallest to largest based on resistance! PROCEDURE COMPLETE! My daughter was taken to recovery where her care was just as exceptional. Upon awakening, her education and treatment continued. The counselor (Dr Pacik), began working with his patient, reassuring her of how well she did and how well she would continue to do. The discussions were intense and extremely detailed. THE THINGS A FATHER WILL DO FOR HIS DAUGHTER! Once we got beyond the snickers and jokes (mostly mine), I realized my daughter had a glow and or sparkle in her eye, I had not seen in a long time! I could see it was her self esteem and her self worth . After multiple self treatments with different dialators, my daughter knew she was like everyone else, she just needed that little extra intervention. I am a very sensitive man, sensitive to all people and their plights, however, my sensitivity reached new levels seeing my daughter’s eyes, her smile and her ability to open up to me , her father! My baby has a boyfriend who I give an abundance of credit to! Most boys would run, run to the next one, he understands and continues to show his support. I cant wait to meet him!! I have never seen a physician exhibit so much passion, warmth, understanding for his patients. His need to succeed , not for himself but for the young woman he sees is evident in the amount of time he spends, failure is not an option. Vaginismus, a term I have never heard, Ob/Gyn physicians so aware most are not, most do not know who treats Vaginismus. Vaginismus, as big as Erectile Dysfunction, and no one knows… WE MUST GET THE WORD OUT, ITS NOT JUST A DAUGHTER BUT SOMEONE’S MOTHER, OR GRANDMOTHER! THESE WOMEN DESERVE A CHANCE AS WELL Thank you Dr Pacik, and your amazing staff!!!! http://www.vaginismusmd.com/vaginismus-md-forum/?mingleforumaction=viewtopic&t=601

I hope these help you and, again, please know that you have my support 100%!!!

[Heather34]

Hi all. There is an excellent new article published that discusses vaginismus in detail and explores various treatment methods, including Dr. Pacik’s Botox treatment program:

http://www.refinery29.com/2014/07/71427/vaginismus#page-1

The Diagnosis

The article begins with a patient receiving the diagnosis of vaginismus.

The author writes: “My vaginal muscles were having a spasm, similar to the way the epiglottis closes entry to the trachea when swallowing food. My vagina, I thought, was smart. It was protecting me against the evils of this doctor’s plastic stick. The doctor looked concerned. “Have you had sex before?” He asked. My eyes began to water. “Yes,” I said, beginning to cry, “But, it was always painful.” Eventually the doctor told me that, along with ovarian cysts, I had a condition known as vaginismus.”

Where Does Vaginismus Come From?

The article goes on to examine where vaginismus comes from.

The author writes: “The vaginismus studies of Irving Binik, PhD, show that phobia — a fear of vaginal penetration and pain — is what causes the involuntary spasm.Professor Binik explains that it’s unknown how most phobias develop. Past traumatic experiences, which may seem like natural correlations, are not necessarily the cause.”

Treatment

The article goes on to explore various treatment methods.

The author writes:

“In 2014, the main treatment for vaginismus is a combination of physical and psychological therapies … [M]ost sex therapists start women on kegel exercises to learn to voluntarily tighten and relax that PC muscle around the vagina. From there, the patient moves on to a set of dilators … Women get used to inserting these, starting with the smallest and working their way to wider dilators.”

and

“Those with severe cases of vaginismus (who have tried the dilator method without success) have gone the Botox route. Dr. Pacik, the plastic surgeon who developed the Botox treatment program for vaginismus, successfully treated 275 patients since 2005 and continues to have a 97% success rate. Botox injections (which calm the vagina muscles, making penetration possible) are administered when the patient is under anesthesia, and a dilator is then inserted. So, the woman wakes up with the dilator painlessly inside her and finds that penetration is indeed possible. Dr. Pacik adds that “just treating with Botox is not enough…you really have to treat some of the emotional issues…””

The article is very well-written in all regards and I commend the writer for working hard to further spread the word about both the condition of vaginismus and the various treatment methods available.

[socialjazz]

Do normal women consciously relax their PC muscle during intercourse? I am asking this because my wife does not know how to control her PC muscle. Normal people relaxes their PC muscle when urinating and defecating, however, my wife said she uses her stomach muscles for these activities. I am guessing what that means is that she has to use secondary muscles to manipulate her pelvic floor. She does not know how to control her PC muscle at all, in fact, she does not even know where it exists. She also does not have the urge to urinate like most people. Normal people have the common urge in their bladder after a heavy drink but all my wife feels is that “her stomach feels bloated”. This is clearly not normal.

Currently she is able to dilate with the biggest blue and sleep with pink. The blue needs a lot of lube and a bit for force. My penis is smaller than blue but bigger than pink but is still unable to penetrate during normal sex. I am however able to just penetrate immediately after half an hour dilation with blue, but unable to thrust my penis forward. It just won’t bulge. It feels as if she is using her internal force to push me out, and she mentioned that she can’t breathe when my penis is in.

I am at a loss, and feels that this is going to be a losing battle against vaginismus. If she is unable to feel her PC muscle at all and constantly spasm her stomach muscle during intercourse, I just don’t see a solution to this unique problem. Surely there is no such thing as botox to the stomach muscle, is there?

btw, she had her botox injection in Dec 2012. Prior to that, even a Q tip cannot be inserted. After months of dilation, she managed to get from a finger to the blue dilator but progress seems to have stopped for many many months. I live in Asia and is not practically for me to travel to US to see Dr Pacik, but will appreciate any form of advice.